Provider Demographics
NPI:1043614787
Name:PULLEN, SUSAN RAND (MSW, LICSW)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:RAND
Last Name:PULLEN
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ONE MEDICAL CTR. DR.
Mailing Address - Street 2:PEDIATRIC PRIMARY CARE, 6L DHMC
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03756-0001
Mailing Address - Country:US
Mailing Address - Phone:603-653-6035
Mailing Address - Fax:603-650-0910
Practice Address - Street 1:1 MEDICAL CENTER DR
Practice Address - Street 2:PEDIATRIC PRIMARY CARE, 6L
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03756-1000
Practice Address - Country:US
Practice Address - Phone:603-653-6035
Practice Address - Fax:603-650-0910
Is Sole Proprietor?:No
Enumeration Date:2014-10-09
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH18071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical